Gastroenterology[JOURNAL]
Sun
200 papers
Bioactive folate attenuates valproic acid-induced NAFLD in female rats.
Ashraf H, Asif T, Baqir F … +1 more , Naz N
BMC Gastroenterol · 2026 Jun · PMID 42374202 · Full text
BACKGROUND: Nonalcoholic fatty liver disease (NAFLD) is a key contributor to chronic liver diseases. It is defined as hepatic fat accumulation in ≥ 5% of hepatocytes in individuals with minimal or no alcohol consumption...
BACKGROUND: Nonalcoholic fatty liver disease (NAFLD) is a key contributor to chronic liver diseases. It is defined as hepatic fat accumulation in ≥ 5% of hepatocytes in individuals with minimal or no alcohol consumption and no other identifiable causes of liver steatosis. Drug-induced hepatic toxicity is increasingly recognized as a key contributor to the development and progression of NAFLD. Among them, valproic acid (VPA), an antiepileptic drug, is well documented for inducing hepatic steatosis, in addition to interfering with folate metabolism and accelerating the progression of NAFLD. The current study distinctively evaluates the protective role of bioactive folate derivatives (folinic acid and 5-methyltetrahydrofolate) in a VPA-induced NAFLD rat model. METHODS: Adult female Sprague Dawley rats were divided into three groups: control, diseased and treated. Liver function test, histopathological examination, gene expression analysis, and molecular docking were performed. RESULTS: Liver function tests indicated that the increase in alanine aminotransferase, alkaline phosphatase, and total bilirubin levels was highly significant in the diseased group, indicative of hepatic injury. Histopathological examination demonstrated severe steatosis in VPA-treated animals, which was significantly improved in the folate-treated group. The NAFLD Activity Score, a mild NAFLD was observed in the diseased group with a total score of 2. Gene expression studies showed high upregulation of HO-1 and pro-inflammatory cytokines TNF-α and IL-6 in the diseased group, whereas downregulation was observed in folate-treated rats. Furthermore, molecular docking studies indicated that folinic acid and 5mTHF showed high affinities for binding to KEAP1 protein, suggestive of activation of the Nrf2-KEAP1 antioxidant pathway. CONCLUSIONS: Collectively, our data provide significant evidence for the protective potential of bioactive folate supplementation in the amelioration of the VPA-induced liver injury through modulation of oxidative stress, inflammation, and lipid accumulation.
How important is fiber in the Crohn's disease story?
Hansen R
Gastroenterology · 2026 Jun · PMID 42372978 · Publisher ↗
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The effect of TIPS on the development of hepatocellular carcinoma in patients with cirrhosis: a meta-analysis.
Xu X, Jiang M, Fu Y … +1 more , Meng Q
BMC Gastroenterol · 2026 Jun · PMID 42366368 · Full text
BACKGROUND: Liver cirrhosis is a leading cause of global liver-related morbidity and mortality, with hepatocellular carcinoma (HCC) being the most common and fatal complication. Transjugular intrahepatic portosystemic sh...
BACKGROUND: Liver cirrhosis is a leading cause of global liver-related morbidity and mortality, with hepatocellular carcinoma (HCC) being the most common and fatal complication. Transjugular intrahepatic portosystemic shunt (TIPS) is a minimally invasive treatment for ascites and gastrointestinal bleeding in patients with cirrhosis. Whether transjugular intrahepatic portalsystemic shunt (TIPS) increases the incidence of hepatocellular carcinoma (HCC) in patients with cirrhosis remains controversial. This study aimed to explore the association between TIPS and the development of HCC. METHODS: We systematically researched PubMed, Embase, Cochrane Library, and Web of Science databases from their inception until March 7, 2023, to identify eligible studies. The incidence of HCC was extracted and analyzed using a random-effects in RevMan. The primary outcome was the cumulative incidence of HCC, and secondary outcomes included subgroup HCC risk by etiology, stent type, follow-up duration, and overall survival. This study was registered with PROSPERO (CRD42023442262). RESULTS: Ten studies comprising 2753 patients were included. Among the 1070 patients who received TIPS, 11.31% (121/1070 ) developed HCC, compared with 8.85% (149/1683) developed HCC (8.85%) in 1683 non-TIPS patients. TIPS did not increase the incidence of HCC [OR = 1.16, 95%CI (0.76,1.77), P = 0.51, I²=50%]. We then performed the analysis according to etiology and stent type. In studies primarily focused on alcoholic liver disease, TIPS did not increase the incidence of HCC [OR = 1.07 95% CI (0.61,1.88), P = 0.82, I²=67%]. Comparable results were observed in studies predominantly using bare stents [OR = 1.52, 95% CI (0.98,2.37), P = 0.06, I²=12%]. Furthermore, TIPS did not increase the cumulative incidence of cancer in 1 year [OR = 0.73 95%CI (0.20,2.69), P = 0.63, I²=74%] and 5 years [OR = 0.99 95% CI (0.52,1.87), P = 0.96], nor did it affect the survival rate [OR = 1.22,95% CI (0.65,2.32), P = 0.53, I²=44%]. CONCLUSIONS: TIPS is not associated with an increased risk of HCC development in cirrhosis patients. Clinicians can safely select TIPS as a treatment option for cirrhotic patients with portal hypertension, without excessive concern about an elevated risk of HCC associated with the procedure.
Epidemiology and clinical profile of inflammatory bowel disease in Kuwait: a nationwide tertiary care (SEEF-IBD) study.
Shehab M, Alrashed F, Aljabri R … +8 more , Mohammad D, Alessa F, Alqattan E, Malik M, Al-Farhan H, Al-Taweel T, Alfadhli A, Jairath V
BMC Gastroenterol · 2026 Jun · PMID 42366353 · Full text
INTRODUCTION: The prevalence of inflammatory bowel disease (IBD) continues to rise globally, with notable shifts in its epidemiological patterns. However, data on characteristics of IBD in Kuwait remain limited. This stu...
INTRODUCTION: The prevalence of inflammatory bowel disease (IBD) continues to rise globally, with notable shifts in its epidemiological patterns. However, data on characteristics of IBD in Kuwait remain limited. This study aimed to evaluate the demographic and clinical characteristics of IBD in Kuwait. METHODS: We conducted a retrospective cross-sectional study across all 7 tertiary centers in Kuwait. Data was retrieved between November 2025 and December 2025. The primary objective of this study was to report the demographics patterns and phenotypes of IBD in Kuwait. Secondary outcomes were treatment patterns, history of IBD-related surgeries and extraintestinal manifestations (EIM). RESULTS: A total of 1,944 patients with IBD were included, of whom CD was slightly more common than UC (1,002; 51.5% vs. 894; 46%). Among CD patients, ileocolonic disease (L3) was the predominant phenotype (516; 51.5%), and penetrating disease (B3) accounted for 363 (36.2%). Proportion of male, smoker and younger (< 30 years old) patients was higher in patients with penetrating disease (p < 0.001). In UC, left-sided disease (E2: 390; 43.6%) was the dominant phenotype. Biologics were prescribed in 846 (43.5%) patients. A history of IBD-related surgery was reported in 418 patients (21.5%). EIM were present in 719 patients (37%). CONCLUSIONS: This study provides a comprehensive characterization of the demographic patterns of IBD in Kuwait, highlighting a higher prevalence of CD, particularly penetrating phenotypes among younger male patients. These findings reflect the evolving burden of IBD in the Middle East and reinforce the importance of timely diagnosis and ensuring access to effective, targeted therapies.
The association between hyperlipidemia and colorectal adenoma risk: a multivariable clinical study based on lipoprotein profile stratification.
Wen W, Liao L, Ou K … +1 more , Liu C
BMC Gastroenterol · 2026 Jun · PMID 42366352 · Full text
BACKGROUND: The incidence of colorectal cancer (CRC) continues to rise, with colorectal adenoma(CRA) being its primary precancerous lesion. Recent studies suggest that hyperlipidemia may promote adenoma development by in...
BACKGROUND: The incidence of colorectal cancer (CRC) continues to rise, with colorectal adenoma(CRA) being its primary precancerous lesion. Recent studies suggest that hyperlipidemia may promote adenoma development by influencing cell membrane structure, cholesterol metabolism, and inflammatory responses. However, its independent role in the adenoma stage remains unclear. OBJECTIVE: To investigate the association between hyperlipidemia and colorectal adenoma(CRA) risk and to evaluate the dose-response relationship based on lipoprotein profile stratification. METHODS: This single-center retrospective case-control study included 180 patients with colorectal adenoma(CRA) and 80 colonoscopy-negative controls. An additional 80 patients with pathologically confirmed colorectal adenocarcinoma (CRAC) were included as a secondary exploratory comparison group. Demographic characteristics and lipid parameters, including total cholesterol (TC), triglycerides (TG), low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C), were collected. Univariate and multivariable unconditional logistic regression analyses were performed to evaluate associations between lipid abnormalities and colorectal adenoma, with adjustment for age, sex, BMI, smoking, alcohol consumption, and family history of colorectal cancer. Variance inflation factors were calculated to assess multicollinearity. Quartile stratification and restricted cubic spline models were used to explore dose-response patterns, and E-value analysis was performed to assess the potential impact of unmeasured confounding. RESULTS: High TC, high TG, high LDL-C, and low HDL-C were significantly associated with the overall presence of CRA in univariate analysis. After adjustment for potential confounders, these associations remained statistically significant. Quartile stratification showed that higher levels of TC, TG, and LDL-C were associated with progressively higher odds of colorectal adenoma, whereas HDL-C showed an inverse association. The RCS models suggested steeper increases in adenoma odds at higher TC and LDL-C levels, while HDL-C showed an approximately linear inverse association. Although high TG was associated with overall adenoma occurrence, TG levels did not differ significantly across adenoma histological subtypes. Subgroup analyses suggested that smoking, obesity, and family history may modify the associations between dyslipidemia and colorectal adenoma. CONCLUSION: Hyperlipidemia was independently associated with CRA in this retrospective case-control study. A comprehensive dyslipidemic pattern, characterized by elevated TC, TG, and LDL-C and reduced HDL-C, was observed among patients with CRA. Lipoprotein profiles may serve as accessible clinical indicators for colorectal adenoma risk stratification. However, because of the retrospective case-control design, causal inference and temporal relationships cannot be established, and the possibility of reverse causality should be considered.
Systematic immunological evaluation in adult patients with inflammatory bowel disease.
Erdem AC, Ataseven H, Asıl M … +4 more , Arslan S, Ucar R, Soyyigit S, Dertli R
BMC Gastroenterol · 2026 Jun · PMID 42366336 · Full text
BACKGROUND: Inflammatory bowel disease (IBD) has been frequently reported in patients with primary immunodeficiency; however, the frequency and pattern of immunological abnormalities among adult patients with established...
BACKGROUND: Inflammatory bowel disease (IBD) has been frequently reported in patients with primary immunodeficiency; however, the frequency and pattern of immunological abnormalities among adult patients with established IBD remain insufficiently characterized. We aimed to systematically evaluate immunological parameters in adult patients with established IBD. Additionally, we sought to identify clinical factors associated with laboratory-defined immunological deviations. METHODS: In this retrospective observational cohort study, we analyzed 108 adults with Crohn's disease or ulcerative colitis who underwent structured immunological evaluation as part of routine clinical care between 2011 and 2015 (a period of standardized screening). We excluded patients with major causes of secondary immunodeficiency (e.g., advanced renal failure, HIV infection, severe malnutrition). However, we recorded exposure to medications that could potentially cause secondary immunosuppression. The predefined laboratory panel included serum immunoglobulins, vaccine antibody responses, isohemagglutinin titers (not assessed in blood group AB), peripheral lymphocyte subsets (reported as percentages), and neutrophil phagocytic function, interpreted using standardized reference ranges. Immunological findings were categorized according to the IUIS 2025 phenotypic framework. Multivariable logistic regression was performed to assess factors associated with laboratory-defined immunological deviations. RESULTS: Clinically significant immunological disorders were identified in 12 patients (11.1%), and laboratory-defined (defined as combined defects across immune compartments) immunological deviations in 60 patients (55.6%). Reduced CD19⁺ B-cell percentages were observed in 45 patients (42.1%) and decreased NK cell percentages in 17 patients (15.9%). In multivariable analysis, increasing age (OR 1.064 per year; 95% CI 1.029-1.100; p < 0.001) and male sex (OR 3.61; 95% CI 1.32-9.87; p = 0.012) were independently associated with laboratory-defined immunological deviations; medication exposure showed a borderline association (OR 2.78; 95% CI 0.99-7.76; p = 0.052). CONCLUSIONS: In this adult IBD cohort evaluated using a structured laboratory framework, measurable immune alterations were common, although most did not meet criteria for clinically significant immunological disorders. These findings highlight immune heterogeneity in adult IBD and support further prospective studies with longitudinal outcomes to clarify the clinical implications and to define which patient subgroups may benefit from targeted immunological assessment.
Colorectal mucinous adenocarcinoma with signet-ring cells: a case report.
Liu YS, Zeng WT, Ma SY … +1 more , Cao HQ
BMC Gastroenterol · 2026 Jun · PMID 42363138 · Full text
BACKGROUND: In recent years, only a few cases of mucinous adenocarcinoma with signet-ring cell carcinoma (MAC-SRC) have been reported, and detailed endoscopic imaging features remain poorly characterized. This is likely...
BACKGROUND: In recent years, only a few cases of mucinous adenocarcinoma with signet-ring cell carcinoma (MAC-SRC) have been reported, and detailed endoscopic imaging features remain poorly characterized. This is likely because these tumors are often already at an advanced stage at diagnosis, rendering endoscopic examination infeasible. We herein report a young Asian male diagnosed with sigmoid colon MAC-SRC (60% mucinous adenocarcinoma, 40% signet-ring cell carcinoma). CASE PRESENTATION: A 27-year-old male presented with recurrent vomiting for 20 days. Abdominal computed tomography showed marked thickening of the sigmoid colon wall. Colonoscopy demonstrated luminal stenosis and rigidity, with extensive erosive lesions covered by abundant, difficult-to-irrigate white mucus; the lesion measured 8 cm in length. Biopsy confirmed mucinous adenocarcinoma. The patient underwent left hemicolectomy, and postoperative pathology verified MAC-SRC. Four months after initiating chemotherapy, the patient continues treatment with no changes in lifestyle, diet, or work compared to the pre-illness state. CONCLUSIONS: Compared with conventional adenocarcinoma, MAC-SRC in young patients shows distinct clinical features and carries a high risk of missed diagnosis. Colonoscopy with adequate biopsy is essential. This patient initially presented with upper gastrointestinal symptoms, leading to a delay in diagnosis. Timely intervention was initiated following endoscopic detection of mucosal abnormalities and confirmatory biopsy findings. The endoscopic characteristics we describe provide diagnostic evidence for MAC-SRC and have important clinical implications.
Development and validation of a nomogram to predict recurrence after hepatectomy in overweight patients with hepatocellular carcinoma: a retrospective cohort study.
Zhao J, Meng Y, Jiang Z … +5 more , Li Z, Li Y, Liu Y, Bi J, Liu L
BMC Gastroenterol · 2026 Jun · PMID 42363084 · Full text
BACKGROUND: Even after curative hepatectomy, postoperative recurrence remains a major challenge for patients with hepatocellular carcinoma (HCC). Body mass index (BMI) has been associated with the risk of HCC development...
BACKGROUND: Even after curative hepatectomy, postoperative recurrence remains a major challenge for patients with hepatocellular carcinoma (HCC). Body mass index (BMI) has been associated with the risk of HCC development; however, the prognostic impact of high BMI on postoperative recurrence in patients with HCC has not been fully elucidated. OBJECTIVE: To evaluate the risk factors associated with postoperative recurrence in overweight HCC patients with negative surgical margins and to develop a prognostic nomogram for recurrence prediction. METHODS: This single-center retrospective study included 259 overweight patients (BMI ≥ 24 kg/m²) who underwent curative hepatectomy for pathologically confirmed HCC with negative margins. Patients were randomly divided into a training cohort and a validation cohort at a 7:3 ratio. Univariate and multivariate Cox regression analyses were performed to identify independent risk factors associated with recurrence-free survival (RFS), incorporating clinical, laboratory, and pathological variables. A prognostic nomogram was constructed to estimate the 1-, 2-, and 3-year recurrence probabilities. Kaplan-Meier and log-rank tests were used to compare RFS between the high- and low-risk groups. RESULTS: Univariate Cox analysis identified poor preoperative Eastern Cooperative Oncology Group (ECOG) performance status (PS score), high nutrition risk screening (NRS 2002) score, advanced AJCC 8th stage, presence of satellite nodules, vascular invasion, elevated alkaline phosphatase (ALP), and a high platelet-to-lymphocyte ratio (PLR) as risk factors for RFS, whereas prolonged activated partial thromboplastin time (APTT) was a protective factor (all P < .05). Multivariate Cox regression revealed that PS score and NRS 2002 were independent predictors of RFS. In the training cohort, the nomogram demonstrated favorable discrimination, with a concordance index (C-index) of 0.724, and the areas under the ROC curve for predicting 1-, 2-, and 3-year RFS were 0.728, 0.769, and 0.767, respectively; comparable performance was observed in the validation cohort (C-index 0.677; 1-, 2-, and 3-year AUCs of 0.701, 0.717, and 0.832). Decision curve analysis indicated that the predictive performance of the model surpassed that of the China Liver Cancer (CNLC) and Barcelona Clinic Liver Cancer (BCLC) staging systems. Moreover, the high-risk group exhibited significantly poorer RFS compared with the low-risk group (all P < .001). CONCLUSIONS: The proposed nomogram effectively stratifies postoperative recurrence risk and predicts RFS in overweight patients with HCC, providing a valuable tool for individualized prognostic assessment and clinical decision-making. However, due to its retrospective and single-center design, the findings require further validation in large-scale, multicenter studies across diverse populations.
Hepatocellular carcinoma risk reduction associated with antiviral treatment in patients with noncirrhotic chronic hepatitis B: a systematic literature review and comparative meta-analysis.
Mohanty A, Stead AE, Telep LE … +8 more , Singer AW, Curteis T, Zolotor A, Frenette C, Khoshabafard D, Hammond K, McQuaid T, Kelley RK
BMC Gastroenterol · 2026 Jun · PMID 42363070 · Full text
BACKGROUND: Chronic hepatitis B (CHB) affects nearly 300 million people worldwide and is a leading cause of hepatocellular carcinoma (HCC). While cirrhosis is a risk factor for HCC, hepatitis B virus (HBV) DNA integratio...
BACKGROUND: Chronic hepatitis B (CHB) affects nearly 300 million people worldwide and is a leading cause of hepatocellular carcinoma (HCC). While cirrhosis is a risk factor for HCC, hepatitis B virus (HBV) DNA integration can lead to HCC in non-cirrhotic individuals. This study synthesized existing data to compare HCC risk among non-cirrhotic patients treated with antivirals versus those untreated. METHODS: A systematic literature review was conducted. Databases were searched in February 2023 and handsearches were performed to identify studies reporting HCC incidence in non-cirrhotic CHB patients, both treated with antivirals for a mean or median duration of at least three years and untreated. A meta-analysis compared HCC incidence rates between treated and untreated populations. RESULTS: Two thousand, one hundred sixty-four records were screened and 61 publications on 50 studies were included. HCC cumulative incidence rates increased with greater follow-up, ranging from 0 to 3% at one year and 0 to 30% at 10 years. Incidence rates ranged from 0 per 100 to 2.43 per 100 person-years. The comparative meta-analysis of four studies indicated that treated populations had a 40% reduction in HCC incidence compared to untreated groups (incidence rate ratio [IRR]: 0.59; 95% CI: 0.50, 0.69), with incidence rates expressed per 100 person-years. Sensitivity analyses confirmed the robustness of these findings. CONCLUSIONS: Antiviral therapy significantly reduces HCC risk in non-cirrhotic CHB patients. These results, with other literature, support treatment guideline expansion to include non-cirrhotic individuals and prevent HCC development. Further research is necessary to evaluate the impact of early versus late treatment initiation and explore potential differences between antivirals. SYSTEMATIC REVIEW REGISTRATION: PROSPERO ID: CRD42023396260. Date of registration: 11 April 2023.
Procedural efficiency and safety of traction-assisted versus conventional endoscopic submucosal dissection for gastric tumors: a meta-analysis of randomized controlled trials.
Desouky M, Fadeli L, Al Mardini A … +4 more , Elghezewi A, Frandah W, Sherif A, Elhadi M
BMC Gastroenterol · 2026 Jun · PMID 42363063 · Full text
BACKGROUND: Endoscopic submucosal dissection (ESD) is an effective minimally invasive treatment for superficial gastric tumors. However, it is technically demanding and often associated with prolonged procedure time and...
BACKGROUND: Endoscopic submucosal dissection (ESD) is an effective minimally invasive treatment for superficial gastric tumors. However, it is technically demanding and often associated with prolonged procedure time and a risk of adverse events. Traction-assisted ESD (TA-ESD) has been introduced to improve submucosal visualization and procedural efficiency; however, evidence regarding its benefit over conventional ESD (C-ESD) in gastric lesions remains inconsistent. This study aimed to compare procedural efficiency, resection quality, and safety between TA-ESD and C-ESD in patients with superficial gastric tumors. METHODS: We conducted a PRISMA-compliant systematic review and meta-analysis of randomized controlled trials comparing TA-ESD with C-ESD for gastric tumors. Five electronic databases were searched through November 8, 2025. Only trials reporting intention-to-treat or modified intention-to-treat analyses were included. The primary outcome was procedure time. Secondary outcomes included en bloc resection, R0 resection, perforation, delayed bleeding, and traction-related damage to the specimen. Pooled estimates were calculated using the mean difference (MD) and risk ratio (RR). Subgroup analyses were performed based on endoscopist experience, tumor location, and tumor size. RESULTS: Five randomized controlled trials comprising 463 patients (228 TA-ESD and 235 C-ESD) met the inclusion criteria. TA-ESD was associated with a shorter procedure time than C-ESD (mean difference [MD] = -12.45 min, 95% CI: -20.67 to -4.23; P = 0.003); however, this finding was sensitive to leave-one-out analyses, with statistical significance lost after exclusion of either the Bi 2024 or Nagata 2021 trial. Procedure time was lower for both upper/middle-third gastric lesions (MD = -21.21 min, 95% CI: -30.26 to -12.17; P < 0.0001) and lower-third lesions (MD = -10.72 min, 95% CI: -17.79 to -3.64; P = 0.003). En bloc resection rates (risk ratio [RR] = 1.00, 95% CI: 0.98-1.02; P = 0.98) and R0 resection rates (RR = 0.99, 95% CI: 0.93-1.06; P = 0.83) were comparable between groups. There were no differences in perforation (RR = 0.52, 95% CI: 0.07-3.97; P = 0.53) or delayed bleeding (RR = 0.78, 95% CI: 0.29-2.09; P = 0.61). Traction-related specimen damage was rare, with a pooled incidence of 1.3%. CONCLUSION: TA-ESD was associated with shorter procedure time than C-ESD, while maintaining comparable resection quality and safety. However, this association was sensitive to leave-one-out analyses and should therefore be interpreted cautiously. Furthermore, the overall certainty of evidence was limited, with three of five included trials judged to be at high risk of bias, and GRADE certainty for most secondary outcomes rated as low to very low. These limitations, together with the small number of available trials, underscore the need for further large, multicenter randomized studies using standardized traction techniques to better define the efficacy and safety of TA-ESD.
Reply to "Critical Appraisal of the Integrin αV-YAP-CTGF Axis in Congestive Hepatopathy".
Kato S, Hikita H, Takehara T
Gastroenterology · 2026 Jun · PMID 42362095 · Publisher ↗
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Critical Appraisal of the Integrin αV-YAP-CTGF Axis in Congestive Hepatopathy.
Sun J, Guan Z, Liu Y
Gastroenterology · 2026 Jun · PMID 42362094 · Publisher ↗
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A High-Risk Impaction: To Scope or to Stent First?
Li Y, Zhang T, Fang C
Gastroenterology · 2026 Jun · PMID 42362093 · Publisher ↗
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Study on the diagnostic value of lipid and systemic inflammatory markers in colorectal adenomatous polyps and the construction of a diagnostic model.
Yang N, Jin S
BMC Gastroenterol · 2026 Jun · PMID 42351031 · Full text
OBJECTIVE: Colorectal adenomatous polyps are well-recognized precancerous lesions of colorectal cancer. Early identification and clinial intervention are crucial for reducing the risk of colorectal cancer. This study aim...
OBJECTIVE: Colorectal adenomatous polyps are well-recognized precancerous lesions of colorectal cancer. Early identification and clinial intervention are crucial for reducing the risk of colorectal cancer. This study aimed to systematically investigate the diagnostic value of lipid and systemic inflammatory markers in colorectal adenomatous polyps and to construct a predictive diagnostic model, thereby providing assistance for early clinical identification. METHODS: This retrospective study includes 220 patients with colorectal adenomatous polyps who underwent endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) in the Department of Gastroenterology at the Fourth Affiliated Hospital of Anhui Medical University between January 1, 2023 and December 31, 2023. Concurrently, 220 healthy controls undergoing physical examinations at the hospital's physical examination center during the same period are enrolled. This study aimed to analyze the diagnostic value of lipid indicators (cholesterol, triglycerides, high-density lipoprotein and low-density lipoprotein) and systemic inflammatory markers (NLR, PLR, MLR, SII, SIRI and AISI) in colorectal adenomatous polyps and to construct a diagnostic model to facilitate clinical diagnosis. RESULTS: Baseline data analysis revealed statistically significant differences between the adenoma group and the control group in terms of gender, age, body mass index (BMI), cholesterol (TC), triglycerides (TG), high-density lipoprotein (HDL), low-density lipoprotein (LDL) and systemic inflammatory markers (NLR, PLR, MLR, SII, SIRI and AISI). Univariate and multivariate logistic regression analyses identified male, age, TC, TG and NLR as serving as valuable diagnostic indicators in colorectal adenomatous polyps, with TG showing the highest diagnostic value. The diagnostic nomogram model was constructed using the aforementioned five independent predictors among the variables examined to demonstrate robust discrimination, calibration and clinical utility. CONCLUSION: Abnormal lipid metabolism and systemic inflammatory status serve as valuable diagnostic indicators in colorectal adenomatous polyps. The diagnostic model integrating metabolic and inflammatory markers exhibits certain diagnostic predictive efficacy,which can serve as providing auxiliary support for non-invasive, early screening of colorectal adenomatous polyps.
Prevalence, anatomic-pathologic findings, and associated factors of nontraumatic ileal perforations among patients with gut perforation: a multicenter cross-sectional study.
Waziri MA, Vivian A, Raymond A … +12 more , Lauben AK, Joel W, Edwin M, Peter AJ, Godfroy NB, Sonye K, Molle F, Sikakulya FK, Muhumuza J, Kithinji SM, Kagenderezo BP, Vahwere BM
BMC Gastroenterol · 2026 Jun · PMID 42351025 · Full text
BACKGROUND: Nontraumatic ileal perforation is a cause of obscure peritonitis characterized by severe toxicity and high mortality. This burden is disproportionately greater in LMICs due to poor hygiene practices, burden o...
BACKGROUND: Nontraumatic ileal perforation is a cause of obscure peritonitis characterized by severe toxicity and high mortality. This burden is disproportionately greater in LMICs due to poor hygiene practices, burden of HIV infection, and other comorbidities. This study aimed at determining the prevalence, anatomic-pathologic findings, and factors associated with nontraumatic ileal perforation a multicenter cross‑sectional study at 3 selected hospitals in Uganda. METHODS: This was a cross-sectional study of 149 consecutive sample participants that used a structured checklist. We conducted logistic regression analyses using SPSS v21.0 (IBM), Variables with p < 0.20 in the bivariate analysis were entered into the multivariable logistic regression model, and p < 0.05 was considered statistically significant. RESULTS: Nontraumaticileal perforation was more prevalent among males (20.1%; 149) and peasants/farmers (41.6%; 149) of rural residence (22.1%; 149). The majority of the study participants had typhoid perforations (79.1%; 149). Most ileal perforations occurred 20-39 cm from the ileocecal junction (76.4%; 149), a perforation size/diameter of 0.5-1cm was more common (58.1%; 149), and a single isolated perforation was more common (74.4%; 149). However, all perforations mainly occurred at the ante mesenteric border. Being an HIV-positive person was associated with greater odds of developing NTIP than was being a non-HIV-positive person. AOR 8.344, p = 0.015 (p<0.05). Additionally, patients treated with open and closed pit latrines were more likely to develop nontraumatic perforation than were those treated with water flash latrines. AOR 12.971, p = 0.004 (p < 0.05). CONCLUSION: This study established that nontraumaticileal perforation is more prevalent among male peasants living in rural areas and with typhoid fever and most of ileal perforations were due to typhoid fever.
Gastrointestinal bleeding in patients on venoarterial extracorporeal membrane oxygenation: a multicenter observational study.
Zhang Z, Zhu Y, Zhang G … +6 more , You X, Dong Y, Hu D, Sun H, Li W, Chen X
BMC Gastroenterol · 2026 Jun · PMID 42351017 · Full text
BACKGROUND: Gastrointestinal (GI) bleeding is a common complication in patients treated with venoarterial extracorporeal membrane oxygenation (VA ECMO), yet comprehensive data on its epidemiology, clinical correlates, an...
BACKGROUND: Gastrointestinal (GI) bleeding is a common complication in patients treated with venoarterial extracorporeal membrane oxygenation (VA ECMO), yet comprehensive data on its epidemiology, clinical correlates, and prognostic implications remain inadequately characterized. METHODS: VA ECMO-treated patients at the Emergency Medicine Center of the First Affiliated Hospital with Nanjing Medical University from January 2017 to December 2023 (analysis cohort) and Intensive Care Unit of The First People's Hospital of Suqian from January 2022 to June 2024 (external validation cohort) were enrolled in this study. In the analysis cohort, stabilized inverse probability of treatment weighting (SIPTW) was used to balance baseline characteristics. Least absolute shrinkage and selection operator (LASSO) regression and binary logistic regression were used for variable selection and predictive model construction, respectively. RESULTS: The incidence of GI bleeding was 17.8% (62/349) in the analysis cohort and 12.0% (10/83) in the external validation cohort. After SIPTW adjustment, GI bleeding was significantly associated with higher 28-day mortality (HR = 2.25, 95%CI: 1.67-3.05, P < 0.001). Three independent predictors were identified: continuous renal replacement therapy (CRRT), baseline international normalized ratio (INR), and baseline calcium. The model yielded an area under the curve (AUC) of 0.797 (95%CI: 0.732-0.861) in the training set, 0.803 (95%CI: 0.706-0.900) in the internal validation set, and 0.753 (95%CI: 0.531-0.976) in the external validation cohort. CONCLUSIONS: GI bleeding is linked to elevated mortality risk in VA ECMO-treated patients. CRRT, baseline INR, and baseline calcium are independent predictors of GI bleeding in this population.
Knowledge, attitudes, and practices toward bowel preparation for sedation-assisted colonoscopy among patients with digestive disorders: a structural equation modeling analysis.
Xu J, Zhang Z, Yu L … +1 more , Feng Y
BMC Gastroenterol · 2026 Jun · PMID 42351000 · Full text
BACKGROUND: This study aims to assess the knowledge, attitudes, and practices (KAP) regarding bowel preparation prior to sedation-assisted colonoscopy among patients with digestive disorders. METHODS: A cross-sectional s...
BACKGROUND: This study aims to assess the knowledge, attitudes, and practices (KAP) regarding bowel preparation prior to sedation-assisted colonoscopy among patients with digestive disorders. METHODS: A cross-sectional survey was conducted at Peking University People's Hospital between June and August 2025. Data were collected through structured questionnaires. RESULTS: A total of 459 participants had undergone sedation-assisted colonoscopy. The majority of these patients were female (58.8%), most respondents were undergoing the procedure for the first time (66.9%), primarily due to gastrointestinal symptoms (47.3%). Their knowledge, attitudes, and practices scores were 9.61 ± 6.60 (possible range: 0-18), 30.72 ± 4.29 (possible range: 8-40), and 35.09 ± 5.99 (possible range: 8-40), respectively. SEM analysis showed that knowledge was significantly associated with attitude (β = 0.424, P = 0.006) and practice (β = 0.555, P = 0.025). CONCLUSION: Patients with digestive disorders demonstrated limited knowledge and suboptimal attitudes despite generally favorable bowel preparation practices, with knowledge being most strongly associated with both attitudinal and behavioral outcomes. To enhance overall bowel preparation effectiveness, future interventions should prioritize structured, evidence-based educational strategies that target knowledge deficits and cognitive barriers, particularly among first-time or lower-literacy patients.
Tumor mitochondrial respiration rather than glycolytic activity predicts recurrence in colorectal cancer: an ex vivo bioenergetic profiling study.
Hou WE, Chen CW, Chu YD … +4 more , Lin YH, Chiang JM, Lim SN, Lin WR
BMC Gastroenterol · 2026 Jun · PMID 42350985 · Full text
BACKGROUND: Metabolic reprogramming is a recognized hallmark of colorectal cancer (CRC), yet whether intratumoral bioenergetic capacity directly influences clinical outcomes remains unclear. In particular, the relative p...
BACKGROUND: Metabolic reprogramming is a recognized hallmark of colorectal cancer (CRC), yet whether intratumoral bioenergetic capacity directly influences clinical outcomes remains unclear. In particular, the relative prognostic contributions of mitochondrial respiration and glycolytic activity to postoperative recurrence have not been systematically evaluated. This study aimed to determine whether tumor oxygen consumption rate (OCR) or extracellular acidification rate (ECAR), measured ex vivo by Seahorse bioenergetic assays, is associated with recurrence-free survival (RFS) and overall survival (OS) in patients with resected CRC. METHODS: In a single-center prospective cohort of 104 patients who underwent surgical resection for CRC between 2012 and 2017, paired tumor and adjacent normal mucosal specimens were analyzed using the Seahorse XF24 analyzer to quantify basal OCR and ECAR. Tumors were stratified by cohort median values and by receiver operating characteristic (ROC)-derived cutoffs optimized for recurrence prediction. Associations with RFS and OS were assessed using Kaplan-Meier analysis and Cox proportional hazards regression, adjusting for clinicopathological covariates. RESULTS: Over a median follow-up of 69 months, tumor OCR was significantly lower than that of adjacent normal mucosa (p < 0.001), whereas ECAR did not differ between paired tissues. OCR and ECAR were positively correlated within tumors (R² = 0.268, p < 0.001). In multivariate Cox regression, higher tumor OCR was independently associated with shorter RFS, both as a continuous variable (hazard ratio 1.455 per 1000-unit increase, p = 0.010) and when dichotomized by median or ROC-derived cutoffs (all p < 0.05). ROC analysis demonstrated moderate discriminatory ability for OCR (area under the curve 0.650), whereas ECAR showed no prognostic value. No bioenergetic parameter was significantly associated with OS. CONCLUSIONS: Intratumoral mitochondrial respiratory capacity, rather than glycolytic activity, independently predicts recurrence in resected CRC. These findings suggest that tumor OCR may serve as a functional metabolic biomarker for recurrence risk stratification, warranting prospective validation in independent cohorts.
Predisposing factors and histopathological changes in duodenogastric reflux: a retrospective case-control study.
Karabulut Ü, Yolaçan R, Ebik B … +5 more , Yavuz A, Akkuzu MZ, Bacaksiz F, Ece ÇB, Uçmak F
BMC Gastroenterol · 2026 Jun · PMID 42350971 · Full text
BACKGROUND: Duodenogastric reflux (DGR), defined as the retrograde flow of duodenal contents into the stomach, has an incompletely understood pathophysiology. This study aimed to evaluate the relationship between DGR and...
BACKGROUND: Duodenogastric reflux (DGR), defined as the retrograde flow of duodenal contents into the stomach, has an incompletely understood pathophysiology. This study aimed to evaluate the relationship between DGR and clinical, endoscopic, histopathological, and laboratory parameters in dyspeptic patients, and to assess its association with Helicobacter pylori (H. pylori) infection, intestinal metaplasia, and potential risk factors. METHOD: This retrospective case-control study included 524 patients who underwent upper gastrointestinal endoscopy between January 2017 and December 2022. A total of 287 patients with endoscopic signs of DGR such as bile pooling, mucosal edema, or hyperemia were classified as the DGR group, while 237 patients without these findings served as controls. Clinical, biochemical, endoscopic, and histopathological data were compared, and risk factors were analyzed using multivariate logistic regression. FINDINGS: Chemical gastropathy was significantly more frequent in the DGR group (p < 0.001). There were no significant differences regarding intestinal metaplasia or H. pylori positivity (p > 0.05). The DGR group showed higher total bilirubin and lower albumin levels (p < 0.05). Cholecystectomy and cholelithiasis were identified as independent strong risk factors (p < 0.001), while age contributed modestly; gender and H. pylori infection showed no significant association. CONCLUSIONS: DGR is a multifactorial condition associated with gastric mucosal injury and systemic biomarker changes. A history of cholecystectomy or gallstones markedly increases DGR risk. Its independent role in intestinal metaplasia remains uncertain, warranting further prospective research.
Causal effects of cholelithiasis on hepatopancreatobiliary diseases: a multi-cohort Mendelian randomization study.
An J, Li X, Fu Y … +6 more , Xie H, Gao K, Zeng F, Wang Y, Zhu M, Xiong Y
BMC Gastroenterol · 2026 Jun · PMID 42350965 · Full text
BACKGROUND: Cholelithiasis is commonly associated with multiple hepatopancreatobiliary diseases, yet whether these relationships reflect causal mechanisms or shared risk factors remains unclear. METHODS: We performed a p...
BACKGROUND: Cholelithiasis is commonly associated with multiple hepatopancreatobiliary diseases, yet whether these relationships reflect causal mechanisms or shared risk factors remains unclear. METHODS: We performed a phenome-oriented two-sample Mendelian randomization (MR) analysis to evaluate the causal impact of genetic liability to cholelithiasis across hepatopancreatobiliary outcomes. Independent genome-wide significant variants were selected as instrumental variables. Primary analyses used inverse variance weighting, complemented by sensitivity analyses, reverse MR, and multivariable MR adjusting for body mass index (BMI). RESULTS: Genetic predisposition to cholelithiasis was associated with increased risk of acute pancreatitis and extrahepatic cholangiocarcinoma (eCCA), with consistent directionality across datasets.The association with acute pancreatitis was interpreted as a positive control, whereas the null association with alcohol-induced acute pancreatitis served as a negative control. No causal association was observed for portal vein thrombosis. Sensitivity analyses, including MR-PRESSO and MR Steiger filtering, supported the robustness and directionality of the causal estimates. Reverse MR analyses showed no consistent evidence supporting reverse causality. Multivariable MR indicated that observed effects were not fully explained by BMI-related pathways. CONCLUSION: These findings suggest that cholelithiasis susceptibility may contribute to the broader hepatopancreatobiliary disease network, extending its clinical relevance beyond a localized biliary disorder.
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